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Medicine

2007 Schools Wikipedia Selection. Related subjects: Health and medicine

   Medicine is a branch of health science and the sector of public life
   concerned with maintaining or restoring human health through the study,
   diagnosis, treatment and possible prevention of disease and injury. It
   is both an area of knowledge – a science of body systems, their
   diseases and treatment – and the applied practice of that knowledge.
   Physician examining a child
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   Physician examining a child

Overview

   Western medical care is shared between medical professionals (
   physicians) and other professionals such as physician assistants,
   nurses and pharmacists, sometimes known as allied health professionals.
   Historically, only those with a medical doctorate have been considered
   to practice medicine. Clinicians (licensed professionals who deal with
   patients) can be physicians, nurses, therapists or others. The medical
   profession is the social and occupational structure of the group of
   people formally trained and authorized to apply medical knowledge. Many
   countries and legal jurisdictions have legal limitations on who may
   practice medicine.

   Medicine comprises various specialized sub-branches, such as
   cardiology, pulmonology, neurology, or other fields such as sports
   medicine, research or public health.

   Human societies have had various different systems of health care
   practice since at least the beginning of recorded history. Medicine, in
   the modern period, is the mainstream scientific tradition which
   developed in the Western world since the early Renaissance (around
   1450). Many other traditions of health care are still practiced
   throughout the world; most of these are separate from Western medicine,
   which is also called biomedicine, allopathic medicine or the
   Hippocratic tradition. The most highly developed of these are
   traditional Chinese medicine, Tibetan medicine and the Ayurvedic
   traditions of India and Sri Lanka. Various non-mainstream traditions of
   health care have also developed in the Western world. These systems are
   sometimes considered companions to Hippocratic medicine, and sometimes
   are seen as competition to the Western tradition. Few of them have any
   scientific confirmation of their tenets, because if they did they would
   be brought into the fold of Western medicine.

   "Medicine" is also often used amongst medical professionals as
   shorthand for internal medicine. Veterinary medicine is the practice of
   health care in animal species other than human beings.

History of medicine

   Physician treating a patient. Louvre Museum, Paris, France.
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   Physician treating a patient. Louvre Museum, Paris, France.

   The earliest type of medicine in most cultures was the use of plants (
   Herbalism) and animal parts. This was usually in concert with 'magic'
   of various kinds in which: animism (the notion of inanimate objects
   having spirits); spiritualism (here meaning an appeal to gods or
   communion with ancestor spirits); shamanism (the vesting of an
   individual with mystic powers); and divination (the supposed obtaining
   of truth by magic means), played a major role.

   The practice of medicine developed gradually, and separately, in
   ancient Egypt, India, China, Greece, Persia and elsewhere. Medicine as
   it is practiced now developed largely in the late eighteenth century
   and early nineteenth century in England (William Harvey, seventeenth
   century), Germany ( Rudolf Virchow) and France ( Jean-Martin Charcot,
   Claude Bernard and others). The new, "scientific" medicine (where
   results are testable and repeatable) replaced early Western traditions
   of medicine, based on herbalism, the Greek " four humours" and other
   pre-modern theories. The focal points of development of clinical
   medicine shifted to the United Kingdom and the USA by the early 1900s
   (Canadian-born) Sir William Osler, Harvey Cushing). Possibly the major
   shift in medical thinking was the gradual rejection in the 1400's of
   what may be called the 'traditional authority' approach to science and
   medicine. This was the notion that because some prominent person in the
   past said something must be so, then that was the way it was, and
   anything one observed to the contrary was an anomaly (which was
   paralleled by a similar shift in European society in general - see
   Copernicus's rejection of Ptolemy's theories on astronomy). People like
   Vesalius led the way in improving upon or indeed rejecting the theories
   of great authorities from the past such as Galen, Hippocrates, and
   Avicenna/ Ibn Sina, all of whose theories were in time almost totally
   discredited. Such new attitudes were also only made possible by the
   weakening of the Roman Catholic church's power in society, especially
   in the Republic of Venice.

   Evidence-based medicine is a recent movement to establish the most
   effective algorithms of practice (ways of doing things) through the use
   of the scientific method and modern global information science by
   collating all the evidence and developing standard protocols which are
   then disseminated to healthcare providers. One problem with this 'best
   practice' approach is that it could be seen to stifle novel approaches
   to treatment.

   Genomics and knowledge of human genetics is already having some
   influence on medicine, as the causative genes of most monogenic genetic
   disorders have now been identified, and the development of techniques
   in molecular biology and genetics are influencing medical practice and
   decision-making.

   Pharmacology has developed from herbalism and many drugs are still
   derived from plants (atropine, ephedrine, warfarin, aspirin, digoxin,
   vinca alkaloids, taxol, hyoscine, etc). The modern era really began
   with Koch's discoveries around 1880 of the transmission of disease by
   bacteria, and then the discovery of antibiotics shortly thereafter
   around 1900. The first major class of antibiotics was the sulfa drugs,
   derived originally from azo dyes. Throughout the twentieth century,
   major advances in the treatment of infectious diseases were observable
   in (Western) societies. The medical establishment is now developing
   drugs that are targeted towards one particular disease process. Thus
   drugs are being developed to minimise the side effects of prescribed
   drugs, to treat cancer, geriatric problems, long-term problems (such as
   high cholesterol), chronic diseases type 2 diabetes, lifestyle and
   degenerative diseases such as arthritis and Alzheimer's disease.

Practice of medicine

   The practice of medicine combines both science as the evidence base and
   art in the application of this medical knowledge in combination with
   intuition and clinical judgement to determine the treatment plan for
   each patient.

   Central to medicine is the patient- physician relationship established
   when a person with a health concern seeks a physician's help; the
   'medical encounter'. Other health professionals similarly establish a
   relationship with a patient and may perform various interventions, e.g.
   nurses, radiographers and therapists.

   As part of the medical encounter, the healthcare provider needs to:
     * develop a relationship with the patient
     * gather data ( medical history, systems enquiry, and physical
       examination, combined with laboratory or imaging studies
       (investigations))
     * analyze and synthesize that data (assessment and/or differential
       diagnoses), and then:
     * develop a treatment plan (further testing, therapy, watchful
       observation, referral and follow-up)
     * treat the patient accordingly
     * assess the progress of treatment and alter the plan as necessary
       (management).

   The medical encounter is documented in a medical record, which is a
   legal document in many jurisdictions.

Health care delivery systems

   Medicine is practiced within the medical system, which is a legal,
   credentialing and financing framework, established by a particular
   culture or government. The characteristics of a health care system have
   significant effect on the way medical care is delivered.

   Financing has a great influence as it defines who pays the costs. Aside
   from tribal cultures, the most significant divide in developed
   countries is between universal health care and market-based health care
   (such as practiced in the U.S.). Universal health care might allow or
   ban a parallel private market. The latter is described as single-payor
   system.

   Transparency of information is another factor defining a delivery
   system. Access to information on conditions, treatments, quality and
   pricing greatly affects the choice by patients / consumers and
   therefore the incentives of medical professionals. While US health care
   system has come under fire for lack of openness, new legislation may
   encourage greater openness. There is a perceived tension between the
   need for transparency on the one hand and such issues as patient
   confidentiality and the possible exploitation of information for
   commercial gain on the other.

Health care delivery

   Paint of Henriette Browne
   Enlarge
   Paint of Henriette Browne

   Medical care delivery is classified into primary, secondary and
   tertiary care.

   Primary care medical services are provided by physicians or other
   health professionals who has first contact with a patient seeking
   medical treatment or care. These occur in physician's office, clinics,
   nursing homes, schools, home visits and other places close to patients.
   About 90% of medical visits can be treated by the primary care
   provider. These include treatment of acute and chronic illnesses,
   preventive care and health education for all ages and both sexes.

   Secondary care medical services are provided by medical specialists in
   their offices or clinics or at local community hospitals for a patient
   referred by a primary care provider who first diagnosed or treated the
   patient. Referrals are made for those patients who required the
   expertise or procedures performed by specialists. These include both
   ambulatory care and inpatient services, emergency rooms, intensive care
   medicine, surgery services, physical therapy, labor and delivery,
   endoscopy units, diagnostic laboratory and medical imaging services,
   hospice centers, etc. Some primary care providers may also take care of
   hospitalized patients and deliver babies in a secondary care setting.

   Tertiary care medical services are provided by specialist hospitals or
   regional centers equipped with diagnostic and treatment facilities not
   generally available at local hospitals. These include trauma centers,
   burn treatment centers, advanced neonatology unit services, organ
   transplants, high-risk pregnancy, radiation oncology, etc.

   Modern medical care also depends on information - still delivered in
   many health care settings on paper records, but increasingly nowadays
   by electronic means.

Physician-patient relationship

   The physician- patient relationship and interaction is a central
   process in the practice of medicine. There are many perspectives from
   which to understand and describe it.

   An idealized physician's perspective, such as is taught in medical
   school, sees the core aspects of the process as the physician learning
   the patient's symptoms, concerns and values; in response the physician
   examines the patient, interprets the symptoms, and formulates a
   diagnosis to explain the symptoms and their cause to the patient and to
   propose a treatment. The job of a physician is similar to a human
   biologist: that is, to know the human frame and situation in terms of
   normality. Once the physician knows what is normal and can measure the
   patient against those norms, he or she can then determine the
   particular departure from the normal and the degree of departure. This
   is called the diagnosis.

   The four great cornerstones of diagnostic medicine are anatomy
   (structure: what is there), physiology (how the structure/s work),
   pathology (what goes wrong with the anatomy and physiology) and
   psychology (mind and behaviour). In addition, the physician should
   consider the patient in their 'well' context rather than simply as a
   walking medical condition. This means the socio-political context of
   the patient (family, work, stress, beliefs) should be assessed as it
   often offers vital clues to the patient's condition and further
   management. In more detail, the patient presents a set of complaints
   (the symptoms) to the physician, who then obtains further information
   about the patient's symptoms, previous state of health, living
   conditions, and so forth. The physician then makes a review of systems
   (ROS) or systems enquiry, which is a set of ordered questions about
   each major body system in order: general (such as weight loss),
   endocrine, cardio-respiratory, etc. Next comes the actual physical
   examination; the findings are recorded, leading to a list of possible
   diagnoses. These will be in order of probability. The next task is to
   enlist the patient's agreement to a management plan, which will include
   treatment as well as plans for follow-up. Importantly, during this
   process the healthcare provider educates the patient about the causes,
   progression, outcomes, and possible treatments of his ailments, as well
   as often providing advice for maintaining health. This teaching
   relationship is the basis of calling the physician doctor, which
   originally meant "teacher" in Latin. The patient- physician
   relationship is additionally complicated by the patient's suffering
   (patient derives from the Latin patior, "suffer") and limited ability
   to relieve it on his/her own. The physician's expertise comes from his
   knowledge of what is healthy and normal contrasted with knowledge and
   experience of other people who have suffered similar symptoms
   (unhealthy and abnormal), and the proven ability to relieve it with
   medicines ( pharmacology) or other therapies about which the patient
   may initially have little knowledge, although the latter may be better
   performed by a pharmacist.

   The physician-patient relationship can be analyzed from the perspective
   of ethical concerns, in terms of how well the goals of non-maleficence,
   beneficence, autonomy, and justice are achieved. Many other values and
   ethical issues can be added to these. In different societies, periods,
   and cultures, different values may be assigned different priorities.
   For example, in the last 30 years medical care in the Western World has
   increasingly emphasized patient autonomy in decision making.

   The relationship and process can also be analyzed in terms of social
   power relationships (e.g., by Michel Foucault), or economic
   transactions. Physicians have been accorded gradually higher status and
   respect over the last century, and they have been entrusted with
   control of access to prescription medicines as a public health measure.
   This represents a concentration of power and carries both advantages
   and disadvantages to particular kinds of patients with particular kinds
   of conditions. A further twist has occurred in the last 25 years as
   costs of medical care have risen, and a third party (an insurance
   company or government agency) now often insists upon a share of
   decision-making power for a variety of reasons, reducing freedom of
   choice of healthcare providers and patients in many ways.

   The quality of the patient- physician relationship is important to both
   parties. The better the relationship in terms of mutual respect,
   knowledge, trust, shared values and perspectives about disease and
   life, and time available, the better will be the amount and quality of
   information about the patient's disease transferred in both directions,
   enhancing accuracy of diagnosis and increasing the patient's knowledge
   about the disease. Where such a relationship is poor the physician's
   ability to make a full assessment is compromised and the patient is
   more likely to distrust the diagnosis and proposed treatment. In these
   circumstances and also in cases where there is genuine divergence of
   medical opinions, a second opinion from another physician may be
   sought.

   In some settings, e.g. the hospital ward, the patient-physician
   relationship is much more complex, and many other people are involved
   when somebody is ill: relatives, neighbors, rescue specialists, nurses,
   technical personnel, social workers and others.

Clinical skills

   A complete medical evaluation includes a medical history, a systems
   enquiry, a physical examination, appropriate laboratory or imaging
   studies, analysis of data and medical decision making to obtain
   diagnoses, and a treatment plan.

   The components of the medical history are:
     * Chief complaint (CC): the reason for the current medical visit.
       These are the 'symptoms.' They are in the patient's own words and
       are recorded along with the duration of each one. Also called
       'presenting complaint.'
     * History of present illness / complaint (HPI): the chronological
       order of events of symptoms and further clarification of each
       symptom.
     * Current activity: occupation, hobbies, what the patient actually
       does.
     * Medications: what drugs the patient takes including
       over-the-counter, and home remedies, as well as herbal
       medicines/herbal remedies such as St. John's Wort. Allergies are
       recorded.
     * Past medical history (PMH/PMHx): concurrent medical problems, past
       hospitalizations and operations, injuries, past infectious diseases
       and/or vaccinations, history of known allergies.
     * Social history (SH): birthplace, residences, marital history,
       social and economic status, habits (including diet, medications,
       tobacco, alcohol).
     * Family history (FH): listing of diseases in the family that may
       impact the patient. A family tree is sometimes used.

     * Review of systems (ROS) or systems enquiry: an set of additional
       questions to ask which may be missed on HPI, generally following
       the body's main organ systems ( heart, lungs, digestive tract,
       urinary tract, etc).

   The physical examination is the examination of the patient looking for
   signs of disease ('Symptoms' are what the patient volunteers, 'signs'
   are what the healthcare provider detects by examination). The
   healthcare provider uses the senses of sight, hearing, touch, and
   sometimes smell (taste has been made redundant by the availability of
   modern lab tests). Four chief methods are used: inspection, palpation
   (feel), percussion (tap to determine resonance characteristics), and
   auscultation (listen); smelling may be useful (e.g. infection, uremia,
   diabetic ketoacidosis). The clinical examination involves study of:
     * Vital signs including height, weight, body temperature, blood
       pressure, pulse, respiration rate, hemoglobin oxygen saturation
     * General appearance of the patient and specific indicators of
       disease (nutritional status, presence of jaundice, pallor or
       clubbing)
     * Skin
     * Head, eye, ear, nose, and throat (HEENT)
     * Cardiovascular ( heart and blood vessels)
     * Respiratory (large airways and lungs)
     * Abdomen and rectum
     * Genitalia (and pregnancy if the patient is or could be pregnant)
     * Musculoskeletal (spine and extremities)
     * Neurological (consciousness, awareness, brain, cranial nerves,
       spinal cord and peripheral nerves)
     * Psychiatric (orientation, mental state, evidence of abnormal
       perception or thought)

   Laboratory and imaging studies results may be obtained, if necessary.

   The medical decision-making (MDM) process involves analysis and
   synthesis of all the above data to come up with a list of possible
   diagnoses (the differential diagnoses), along with an idea of what
   needs to be done to obtain a definitive diagnosis that would explain
   the patient's problem.

   The treatment plan may include ordering additional laboratory tests and
   studies, starting therapy, referral to a specialist, or watchful
   observation. Follow-up may be advised.

   This process is used by primary care providers as well as specialists.
   It may take only a few minutes if the problem is simple and
   straightforward. On the other hand, it may take weeks in a patient who
   has been hospitalized with bizarre symptoms or multi-system problems,
   with involvement by several specialists.

   On subsequent visits, the process may be repeated in an abbreviated
   manner to obtain any new history, symptoms, physical findings, and lab
   or imaging results or specialist consultations.

Branches of medicine

   Working together as an interdisciplinary team, many highly trained
   health professionals besides medical practitioners are involved in the
   delivery of modern health care. Some examples include: nurses,
   laboratory scientists, pharmacists, physiotherapists, respiratory
   therapists, speech therapists, occupational therapists, dietitians and
   bioengineers.

   The scope and sciences underpinning human medicine overlap many other
   fields. Dentistry and psychology, while separate disciplines from
   medicine, are considered medical fields.

Midlevel Practitioner

   Physician assistants, nurse practitioners and midwives treat patients
   and prescribe medication in many legal jurisdictions.

Veterinary Medicine

   Veterinarians applies similar techniques as physicians to the care of
   animals.

   Physicians have many specializations and subspecializations which are
   listed below. There are variations from country to country regarding
   which specialities certain subspecialities are in.

Diagnostic specialties

     * Clinical laboratory sciences are the clinical diagnostic services
       which apply laboratory techniques to diagnosis and management of
       patients. In the United States these services are supervised by a
       pathologist. The personnel that work in these medical laboratory
       departments are technically trained staff, each of whom usually
       hold a medical technology degree, who actually perform the tests,
       assays, and procedures needed for providing the specific services.

     * Pathology is the branch of medicine that deals with the study of
       diseases and the morphologic, physiologic changes produced by them.
       As a diagnostic specialty, pathology can be considered the basis of
       modern scientific medical knowledge and plays a large rôle in
       evidence-based medicine. Many modern molecular tests such as flow
       cytometry, polymerase chain reaction (PCR), immunohistochemistry,
       cytogenetics, gene rearragements studies and fluorescent in situ
       hybridization (FISH) fall within the territory of pathology.

     * Radiology is concerned with imaging of the human body, e.g. by
       x-rays, x-ray computed tomography, ultrasonography, and nuclear
       magnetic resonance tomography.

Clinical disciplines

     * Anesthesiology (AE) or anaesthesia (BE) is the clinical discipline
       concerned with providing anesthesia. Pain medicine is often
       practiced by specialised anesthesiologists.
     * Dermatology is concerned with the skin and its diseases. In the UK,
       dermatology is a subspeciality of general medicine.
     * Emergency medicine is concerned with the diagnosis and treatment of
       acute or life-threatening conditions, including trauma, surgical,
       medical, pediatric, and psychiatric emergencies.
     * General practice, family practice, family medicine or primary care
       is, in many countries, the first port-of-call for patients with
       non-emergency medical problems. Family practitioners are usually
       able to treat over 90% of all complaints without referring to
       specialists.
     * Hospital medicine is the general medical care of hospitalized
       patients. Physicians whose primary professional focus is hospital
       medicine are called hospitalists in the USA.
     * Internal medicine is concerned with systemic diseases of adults,
       i.e. those diseases that affect the body as a whole (restrictive,
       current meaning), or with all adult non-operative somatic medicine
       (traditional, inclusive meaning), thus excluding pediatrics,
       surgery, gynecology and obstetrics, and psychiatry. There are
       several subdisciplines of internal medicine:
          + Cardiology
          + Endocrinology
          + Gastroenterology
          + Hematology
          + Infectious Diseases
          + Intensive care medicine
          + Nephrology
          + Oncology
          + Pulmonology
          + Rheumatology
     * Neurology is concerned with the diagnosis and treatment of nervous
       system diseases. It is a subspeciality of general medicine in the
       UK.
     * Obstetrics and gynecology (often abbreviated as Ob/Gyn) are
       concerned respectively with childbirth and the female reproductive
       and associated organs. Reproductive medicine and fertility medicine
       are generally practiced by gynecological specialists.
     * Palliative care is a relatively modern branch of clinical medicine
       that deals with pain and symptom relief and emotional support in
       patients with terminal illnesses including cancer and heart
       failure.
     * Pediatrics (AE) or paediatrics (BE) is devoted to the care of
       infants, children, and adolescents. Like internal medicine, there
       are many pediatric subspecialities for specific age ranges, organ
       systems, disease classes, and sites of care delivery. Most
       subspecialities of adult medicine have a pediatric equivalent such
       as pediatric cardiology, pediatric endocrinology, pediatric
       gastroenterology, pediatric hematology, pediatric oncology,
       pediatric ophthalmology, and neonatology.
     * Physical medicine and rehabilitation (or physiatry) is concerned
       with functional improvement after injury, illness, or congenital
       disorders.
     * Preventive medicine is the branch of medicine concerned with
       preventing disease.
     * Psychiatry is the branch of medicine concerned with the
       bio-psycho-social study of the etiology, diagnosis, treatment and
       prevention of cognitive, perceptual, emotional and behavioural
       disorders. Related non-medical fields include psychotherapy and
       clinical psychology.
     * Radiation therapy is concerned with the therapeutic use of ionizing
       radiation and high energy elementary particle beams in patient
       treatment.
     * Radiology is concerned with the interpretation of imaging
       modalities including x-rays, ultrasound, radioisotopes, and MRI
       (Magnetic Resonance Imaging). A newer branch of radiology,
       interventional radiology, is concerned with using medical devices
       to access areas of the body with minimally invasive techniques.
     * Surgical specialties employ operative treatment. These include
       Orthopedics, Urology, Ophthalmology, Neurosurgery, Plastic Surgery,
       Otolaryngology and various subspecialties such as transplant and
       cardiothoracic. Some disciplines are highly specialized and are
       often not considered subdisciplines of surgery, although their
       naming might suggest so.
     * Urgent care focuses on delivery of unscheduled, walk-in care
       outside of the hospital emergency department for injuries and
       illnesses that are not severe enough to require care in an
       emergency department.
     * Gender-based medicine studies the biological and physiological
       differences between the human sexes and how that affects
       differences in disease.

Interdisciplinary fields

   Interdisciplinary sub-specialties of medicine are:
     * Aerospace medicine deals with medical problems related to flying
       and space travel.
     * Bioethics is a field of study which concerns the relationship
       between biology, science, medicine and ethics, philosophy and
       theology.
     * Biomedical Engineering is a field dealing with the application of
       engineering principles to medical practice.
     * Clinical pharmacology is concerned with how systems of therapeutics
       interact with patients.
     * Conservation medicine studies the relationship between human and
       animal health, and environmental conditions. Also known as
       ecological medicine, environmental medicine, or medical geology.
     * Diving medicine (or hyperbaric medicine) is the prevention and
       treatment of diving-related problems.
     * Evolutionary medicine is a perspective on medicine derived through
       applying evolutionary theory.
     * Forensic medicine deals with medical questions in legal context,
       such as determination of the time and cause of death.
     * Medical humanities includes the humanities (literature, philosophy,
       ethics, history and religion), social science (anthropology,
       cultural studies, psychology, sociology), and the arts (literature,
       theatre, film, and visual arts) and their application to medical
       education and practice.
     * eHealth, Medical informatics, and medical computer science are
       relatively recent fields that deal with the application of
       computers and information technology to medicine.
     * Nosology is the classification of diseases for various purposes.
     * Pharmacogenomics is a form of individualized medicine.
     * PanVascular Medicine is an approach to deal with the problems of
       highly specialised but both, medical and economical inefficiently
       arranged human resources and medical equipment in today's vascular
       care facilities
     * Sports medicine deals with the treatment and preventive care of
       athletics, amateur and professional. The team includes specialty
       physicians and surgeons, athletic trainers, physical therapists,
       coaches, other personnel, and, of course, the athlete.
     * Therapeutics is the field, more commonly referenced in earlier
       periods of history, of the various remedies that can be used to
       treat disease and promote health .
     * Travel medicine or emporiatrics deals with health problems of
       international travelers or travelers across highly different
       environments.

Medical education

   An image of a 1901 examination in the faculty of medicine.
   Enlarge
   An image of a 1901 examination in the faculty of medicine.

   Medical education is education related to the practice of being a
   medical practitioner, either the initial training to become a physician
   or further training thereafter.

   Medical education and training varies considerably across the world,
   however typically involves entry level education at a university
   medical school, followed by a period of supervised practice (
   Internship and/or Residency) and possibly postgraduate vocational
   training. Continuing medical education is a requirement of many
   regulatory authorities.

   Various teaching methodologies have been utilised in medical education,
   which is an active area of educational research.

Legal restrictions

   In most countries, it is a legal requirement for medical doctors to be
   licensed or registered. In general, this entails a medical degree from
   a university and accreditation by a medical board or an equivalent
   national organization, which may ask the applicant to pass exams. This
   restricts the considerable legal authority of the medical profession to
   physicians that are trained and qualified by national standards. It is
   also intended as an assurance to patients and as a safeguard against
   charlatans that practice inadequate medicine for personal gain. While
   the laws generally require medical doctors to be trained in "evidence
   based", Western, or Hippocratic Medicine, they are not intended to
   discourage different paradigms of health and healing, such as
   alternative medicine or faith healing.

Criticism

   Criticism of medicine has a long history. In the Middle Ages, some
   people did not consider it a profession suitable for Christians, as
   disease was often considered God sent. God was considered to be the
   'divine physician' who sent illness or healing depending on his will.
   However many monastic orders, particularly the Benedictines, considered
   the care of the sick as their chief work of mercy. Barber-surgeons
   (they had the sharpest knives) generally had a bad reputation that was
   not to improve until the development of academic surgery as a
   speciality of medicine, rather than an accessory field.

   Through the course of the twentieth century, healthcare providers
   focused increasingly on the technology that was enabling them to make
   dramatic improvements in patients' health. The ensuing development of a
   more mechanistic, detached practice, with the perception of an
   attendant loss of patient-focused care, known as the medical model of
   health, led to further criticisms. This issue started to reach
   collective professional consciousness in the 1970s and the profession
   had begun to respond by the 1980s and 1990s.

   Perhaps the most devastating criticism of modern medicine came from
   Ivan Illich. In his 1976 work Medical Nemesis, Illich stated that
   modern medicine only medicalises disease and causes loss of health and
   wellness, while generally failing to restore health by eliminating
   disease. This medicalisation of disease forces the human to become a
   lifelong patient.Other less radical philosophers have voiced similar
   views, but none were as virulent as Illich. Another example can be
   found in Technopoly: The Surrender of Culture to Technology by Neil
   Postman, 1992, which criticises overreliance on technological means in
   medicine.

   Criticism of modern medicine has led to some improvements in the
   curricula of medical schools, which now teach students systematically
   on medical ethics, holistic approaches to medicine, the biopsychosocial
   model and similar concepts.

   The inability of modern medicine to properly address many common
   complaints continues to prompt many people to seek support from
   alternative medicine. Although most alternative approaches lack
   scientific validation, some may be effective in individual cases. The
   bioscience and alternative health care paradigms may differ to such an
   extent that what constitutes scientific evidence is contested. Many
   physicians practice alternative medicine alongside "orthodox"
   approaches but the general body of medical practitioners is often
   criticised for ignoring the purported value of alternative medicine.

   Medical errors are also the focus of many complaints and negative
   coverage. Practitioners of human factors engineering believe that there
   is much that medicine may usefully gain by emulating concepts in
   aviation safety, where it was long ago realized that it is dangerous to
   place too much responsibility on one "superhuman" individual and expect
   him or her not to make errors. Reporting systems and checking
   mechanisms are becoming more common in identifying sources of error and
   improving practice.

   Radical critics of certain medical traditions may hold that whole
   fields or traditions of medicine are intrinsically harmful or
   ineffective. They would reject any use or support of practices
   belonging to that tradition. However, generally, there is a spectrum of
   efficacy on which all traditions lie; some are more effective, some are
   less effective, but nearly all contain some harmful practices and some
   effective ones. Naturally, though, most individuals or groups seeking a
   health care practice to improve their own health would seek a tradition
   with the maximum degree of efficacy. There is no doubt whatsoever that
   Western Allopathic medicine, together with its cohorts of improved
   hygiene and nutrition, have been collectively responsible for most of
   the improvements in health worldwide over the last century or so,
   including: increasing longevity, decreased child mortality, increasing
   population numbers, better ability to monitor and halt disease spread
   and outbreaks, improved access to health care for all strata of
   society.

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